Stability of extended-family households when most needed: Older Indians’ disability and living arrangements following extreme coastal-urban flooding events

As is typical in low and middle-income countries (LMICs), India’s offspring frequently support their parents in old age through household co-residence. This may mitigate adverse health outcomes from natural disasters. We consider dynamic associations of increases in older adult disability and of stability of extended-family household structures. We compare these two outcomes between older persons experiencing the extreme flooding events that occurred in each of India’s four largest coastal cities over the years 2005 to 2007 and older persons living in other urban areas and in rural areas. Our analyses are of a population-representative sample of adults aged 50 and over in the 2004/05 first wave, and age 57 and over in the 2011/12 second wave, of the India Human Development Survey (IHDS) panel survey. We estimate multivariable regressions respectively for the between-wave outcomes of disability and impairment change and for the stability of older persons’ extended-family living arrangements. We find that increases in impairments, but not in restrictions to activities of daily living (ADLs), were associated with living in one of the large coastal cities. We find greater stability of extended-family household structures both for older persons living in one of the large coastal cities and for older persons who experienced increases in ADLs. We conclude favorably for the protective role of extended-family household structures of India’s older persons, and suggest that these will be protective also for those older persons exposed to unfavorable health impacts of disaster events in the coastal megacities of LMICs more broadly.